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      <h4 class="scenarios"><a href="implementation.html" class="blue">NwHIN 1.0 Portfolio</a> > <a href="scenarios.html" class="blue">Scenarios</a> > <a href="scenario_toc2.html" class="blue">Transferring Records between Providers</a></h4>
      <h1 class="testimonials">Transferring Records between Providers</h1>
      <h6>A physician transfers a patient's medical records to a different provider practice:</h6>
      <div class="scenario_center"><p><img src="images/scenario_TOC2.png" alt="S&amp;I Scenarios" title="A flow diagram illustrating the transfer of medical records between physicians via Direct. The physician sends the document to the dermatology practice’s Direct group address, which is verified in the Provider Directory. The message passes through the physician’s HISP, where it is encrypted and sent to the dermatology practice’s HISP. The practice coordinator selects a specialist who is available for a new patient and routes an appointment and the medical record to the specialist."/></p></div>
      <p>A patient is referred to a dermatologist practice by his primary care physician. Because the patient&rsquo;s conditions require care from a dermatological specialist but are not unique enough to necessitate a visit from a particular type of dermatologist, his primary care physician feels comfortable referring him to a general dermatology practice. The primary care physician transfers his patient&rsquo;s records to the dermatology practice office via a Direct group practice address (one that is not specific to an individual physician).  The dermatology practice coordinator schedules the patient with one of their specialists and the records are forwarded. </p>
      <div class="mu">
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         <td width="40" align="left" valign="top"> <img src="images/clipboard_check.png" alt="Meaningful Use Objectives" /> </td>
         <td width="15">&nbsp;</td>
         <td valign="middle"><p class="mu"><strong>Meaningful Use Stage 2 Objectives related to transitions of care: </strong>The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral. <em>(Meaningful Use Menu Set 15 for EPs, Meaningful Use Menu Set 12 or EH/CAHs)</em></p></td></tr></table>
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      <h6>Common workflow steps for this scenario:</h6>
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         <td width="891" valign="middle">The physician extracts the medical records for the patient from his EHR, which has been properly formatted according to the HL7 CDA Release 2 CCD standard using Logistical Observation Identifiers names and Codes (LOINC) 2.38, RxNorm, and Systemized Nomenclature of Medical--Clinical Terms (SNOMED-CT). He then authors a Direct message and attaches the record. In order to select the patient&rsquo;s new dermatology practice as the recipient, the physician accesses a search dialogue in the Health Information Service Provider&rsquo;s (HISP) user interface, which queries a Provider Directory (adhering to the Certificate Discovery for Direct specification) for the right Direct group practice address.</td>
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         <td width="40" align="left" valign="top"> <img src="images/scenario_2.png" alt="2" /> </td>
         <td width="15">&nbsp;</td>
         <td width="891" valign="middle">When the physician sends the message, it passes through his office&rsquo;s HISP, a contracted brokering agent responsible for the management of security and transport for directed exchange. As it passes through the HISP, the message is encrypted using the x.509 Certificate associated with the physician, and is delivered to the dermatology practice&rsquo;s Direct group address in accordance with the Applicability Statement for Secure Health Transport.</td>
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         <td height="15" align="left" valign="top">&nbsp;</td>
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         <td width="40" align="left" valign="top"><img src="images/scenario_3.png" alt="3" /> </td>
         <td width="15">&nbsp;</td>
         <td width="891" valign="middle">The dermatology practice&rsquo;s HISP decrypts the message and sends it to the practice coordinator who identifies the appropriate specialist within the practice for the patient, schedules the appointment, and uploads the information to the patient&rsquo;s electronic medical record as an attachment, then forwards the record to the specialist before the patient&rsquo;s appointment.</td>
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         <td width="40" align="left" valign="top"><img src="images/scenario_4.png" alt="4" /></td>
         <td width="15">&nbsp;</td>
         <td width="891" valign="middle">The specialist reviews the information in the attachment and determines which data are appropriate for uploading into the patient&rsquo;s medical record as structured data.  The attachment remains associated with the record.</td>
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      <br />
      <h6>NwHIN 1.0 specifications and resources recommended for scenario:</h6>
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              <h4 class="scenario2"> Content Structure</h4>
              Guidance that specifies how to structure health information to ensure proper exchange</td>
            <td align="left" valign="middle" bgcolor="#E6E6E6"><ul>
            <li><a href="https://www.hl7.org/implement/standards/product_brief.cfm?product_id=6" target="_new">HL7 CDA Release 2 CCD</a></li></ul></td>
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              <h4 class="scenario2">Vocabulary &amp; Code Sets</h4>
              Specifications that identify common naming convention necessary for proper health information exchange</td>
            <td align="left" valign="middle" bgcolor="#E6E6E6"><ul>
            <li><a href="http://loinc.org/" target="_new">Logistical Observation Identifiers names and Codes (LOINC)
2.38</a></li>
              <li><a href="http://www.cdc.gov/nchs/icd/icd9cm.htm" target="_new">ICD-9-CM</a></li>
<li><a href="http://www.nlm.nih.gov/research/umls/rxnorm/" target="_new">RxNorm</a></li>
              <li><a href="http://www.ihtsdo.org/join-us/use-snomed-ct-licenses/" target="_new">Systematized Nomenclature of Medicine--Clinical Terms (SNOMED-CT)</a></li>
            </ul></td>
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            <td width="300" align="left" valign="top" bgcolor="#BF311A"><h4 class="scenario2">Transport and Security</h4>
              Mechanisms and processes that safely exchange health information over the Internet</td>
            <td align="left" valign="middle" bgcolor="#E6E6E6"><ul>
              <li><a href="http://wiki.siframework.org/file/view/Certificate Discover for Direct Project Implementation Guide.pdf" target="_new">Certificate Discovery using Domain Name System (DNS) and Lightweight Directory Access Protocol (LDAP)</a></li>
              <li><a href="http://wiki.directproject.org/Applicability+Statement+for+Secure+Health+Transport" target="_new">Applicability Statement for Secure Health Transport</a></li>
              <li><a href="http://tools.ietf.org/html/rfc5280" target="_new">x.509 for Certificates</a></li>
            </ul></td>
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